Provider Demographics
NPI:1164556700
Name:REYNOSO, BYRON OMAR (DPT)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:OMAR
Last Name:REYNOSO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
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Mailing Address - Street 1:16702 VALLEY VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-5824
Mailing Address - Country:US
Mailing Address - Phone:714-367-5360
Mailing Address - Fax:714-635-5428
Practice Address - Street 1:1171 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-8247
Practice Address - Country:US
Practice Address - Phone:951-272-1400
Practice Address - Fax:951-272-9928
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA335352251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic